Individual
MS. LAURA SUZANNE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS - INFANT TODDLER
Contact information
Practice address
1201 W 22ND STREET, PANAMA CITY, FL 32405
(850) 271-0804
Mailing address
PO BOX 2002, LYNN HAVEN, FL 32444
(850) 819-1687
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
811601600
FL
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
811601600
—
FL
Enumeration date
12/04/2006
Last updated
10/31/2012
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